Study Shows Bariatric Surgery Improves Health in Obese Adolescents

A new national study by the University of Miami Miller School of Medicine shows that bariatric surgery can safely and substantially reduce weight and related health problems in morbidly obese adolescents, findings that could change treatment options offered by physicians. Led by Sarah E. Messiah, Ph.D., M.P.H., research associate professor and perinatal/pediatric epidemiologist in the Department of Pediatrics, the study was the first large-scale examination of bariatric surgery outcomes in adolescents.

“Our analysis shows that surgery safely reduced weight and body mass index (BMI) among all gender and ethnic groups,” said Messiah, of the Division of Pediatric Clinical Research in the Batchelor Children’s Research Institute. “Several serious physical and mental health problems, including hypertension, diabetes and depression, also improved substantially one year after surgery, suggesting an improvement in quality of life. These positive outcomes after bariatric surgery have not been documented for other treatment options, and especially in this age group.”

The study, “Changes in weight and co-morbidities among adolescents undergoing bariatric surgery: 1-year results from the Bariatric Outcomes Longitudinal Database,” (BOLD) was published online in Surgery for Obesity and Related Disease, the journal of the American Society for Metabolic and Bariatric Surgery, and will appear in a future print issue. In analyzing the BOLD data, collected from 423 surgeons at 360 U.S. facilities, the researchers found that adolescent males and females who underwent gastric bypass surgery, which reduces stomach size and reroutes the small intestines to the smaller stomach pouch, had an overall one-year mean weight loss that was more than twice as large as those who underwent adjustable gastric band surgery, where a silicon band is placed around the stomach to reduce its size.

“Bariatric surgery resulted in an average weight loss of more than 66 pounds per person, a loss that far exceeds those reported in non-surgical weight-management programs,” said senior author Nestor de la Cruz-Muñoz, M.D., chief of the Division of Laparoendoscopic and Bariatric Surgery. “Our findings show that health problems related to morbid obesity can actually be reversed as a result of bariatric surgery.”

To determine weight loss and health-related outcomes, the Miller School researchers analyzed the national BOLD database, which included all reported bariatric cases performed on patients aged 11 to 20 from every state except Vermont and New Mexico – a total of 890 morbidly obese adolescents. A morbidly obese individual’s weight is above the 97th percentile, significantly increasing the risk of heart and kidney failure, sleep apnea and many other chronic health problems.

While bariatric surgery is one of the few effective treatments of morbid obesity, the outcomes for this procedure were not clear prior to this study, according to co-author Steven E. Lipshultz, M.D., professor of pediatrics, the George Batchelor Endowed Chair in Pediatric Cardiology, and director of the Batchelor Children’s Research Institute.

“While primary care physicians are on the front line of obesity treatment, many do not understand the potential benefits of bariatric surgery,” said Lipshultz, who cited a 2007 national survey that indicated nearly half of pediatricians and family physicians would not send patients younger than 18 for bariatric surgery because of unanswered questions about clinical efficacy and safety. “Now adolescents and their parents, along with their physicians, can make better-informed decisions about treatment options,” he added.

Lipshultz said the study also provides sound policy data regarding the issue of removing morbidly obese adolescents from their family homes, which a 2011 commentary published in the Journal of the American Medical Association suggested. “This is a policy issue that should be based on data-driven facts, rather than emotions,” he said. “By showing bariatric surgery is a proven therapy and a medical necessity for morbidly obese adolescents, our study is a game changer that addresses one of the most important health issues in the nation.”

With only one death, resulting from a cardiac arrest five months after the surgery, reported in the BOLD database, bariatric surgery has a mortality rate substantially lower than almost any other type of surgery, according to Messiah. She added, “The Miller School study sets the stage for further studies to follow these adolescent patients in the years ahead and analyze the long-term results.”

Other Miller School co-authors were Gabriela Lopez-Mitnik, M.S., M.Phil., senior research associate in pediatrics; Kristopher L. Arheart, Ed.D., associate professor of epidemiology and public health; Tracie L. Miller, M.D., professor of pediatrics and director of the Division of Clinical Research; and Alan S. Livingstone, M.D., the Lucille and DeWitt Daughtry Professor and Chairman of the DeWitt Daughtry Family Department of Surgery. Other contributors included Deborah Winegar, Ph.D., and Bintu Sherif, M.S., of the Surgical Review Corporation, Raleigh, North Carolina; Kirk W. Reichard, M.D.; and Marc P. Michalsky, M.D.